SSM Health St. Agnes Hospital - Fond du Lac
430 E Division St, Fond Du Lac, WI · SSM Health · · NPI 1346228541
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Impres&prep surg obt prosth CPT 21076 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Imuglucerase injection HCPCS J1786 | not published | not published | $32.49 – $118.11 | 8 |
| In-111 autologous plt stdy dx HCPCS A9571 | not published | not published | $11,632.29 – $11,632.29 | 1 |
| In-111 autol wbc diag per dose HCPCS A9570 | $983.95 | $1,789.00 | $827.39 – $2,807.95 | 5 |
| In-111 capromab pendet HCPCS A9507 | not published | not published | $1,297.72 – $3,576.24 | 5 |
| In-111 ibritumomab tiux dx HCPCS A9542 | not published | not published | $2,172.60 – $2,172.60 | 1 |
| In-111 oxyquinolin per 0.5 mci HCPCS A9547 | not published | not published | $623.60 – $2,103.52 | 5 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | $636.90 | $1,158.00 | $559.22 – $1,947.38 | 5 |
| In-111 pentetreotide HCPCS A9572 | not published | not published | $1,500.70 – $5,212.53 | 5 |
| In-111 satumomab pend HCPCS A4642 | not published | not published | $4,419.90 – $4,419.90 | 1 |
| Inactivated je vacc im CPT 90738 | not published | not published | $832.29 – $832.29 | 1 |
| Inc deep opng b1 crtx thorax CPT 21510 | not published | not published | $2,427.27 – $16,106.00 | 6 |
| Inc dp bone crtx f/arm&/wrst CPT 25035 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Inc dp opn b1 crtx hum/elbw CPT 23935 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incis 1 vertebral seg cerv CPT 22210 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incis 1 vertebral seg lumbar CPT 22214 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incis 1 vertebral seg thorac CPT 22212 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incis addl spine segment CPT 22216 | not published | not published | $1,887.00 – $3,735.00 | 3 |
| Incise bile duct sphincter CPT 47460 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incise diaphragm nerve CPT 64746 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Incise/drain eyelid lining CPT 68020 | not published | not published | $739.52 – $4,761.00 | 6 |
| Incise flexor carpi radialis CPT 25001 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incise hand/finger tendon CPT 26460 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Incise hip/thigh nerve CPT 64763 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Incise hip/thigh nerve CPT 64766 | not published | not published | $1,448.59 – $8,770.00 | 6 |
| Incise inner ear CPT 69801 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Incise inner ear nerve CPT 69915 | not published | not published | $2,459.51 – $16,106.00 | 6 |
| Incise inner ear nerve CPT 69950 | not published | not published | $4,428.00 – $4,428.00 | 1 |
| Incise inner eye adhesions CPT 65860 | not published | not published | $408.01 – $3,030.00 | 6 |
| Incise inner eye adhesions CPT 65865 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Incise inner eye adhesions CPT 65870 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Incise inner eye adhesions CPT 65875 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Incise inner eye adhesions CPT 65880 | not published | not published | $3,066.31 – $7,890.63 | 6 |
| Incise inner eye strands CPT 67030 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Incise nerve back of head CPT 64744 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Incise perq finger tendon 26060 CPT 26060 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Incise skull/brain surgery CPT 61720 | not published | not published | $4,428.00 – $16,752.93 | 6 |
| Incise skull/brain surgery CPT 61735 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise skull for treatment CPT 61770 | not published | not published | $2,534.21 – $16,106.00 | 6 |
| Incise skull repair CPT 62121 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise skull/sutures CPT 61556 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise skull/sutures CPT 61557 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise sperm duct pouch CPT 55600 | not published | not published | $1,550.71 – $7,791.00 | 6 |
| Incise spinal cord tract(s) CPT 63170 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incise spine accessory nerve CPT 63191 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Incise spine nrv >2 segmnts CPT 63190 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Incise spine nrv half segmnt CPT 63185 | not published | not published | $6,779.00 – $27,583.00 | 3 |
| Incise tear duct opening 68440 CPT 68440 | not published | not published | $235.46 – $2,334.00 | 6 |
| Incise tendon(s) & muscle(s) CPT 23406 | $4,824.05 | $8,771.00 | $3,735.00 – $13,851.98 | 6 |
| Incise thigh tendon & fascia CPT 27305 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incise & treat bladder CPT 51030 | not published | not published | $7,529.00 – $7,791.00 | 2 |
| Incise wrist/forearm tendon CPT 25290 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Incision anal septum infant CPT 46070 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $3,395.15 | $6,173.00 | $1,225.21 – $4,761.00 | 6 |
| Incision & drainage open of deep abscess (subfascial) pos CPT 22010 | not published | not published | $3,388.00 – $18,364.00 | 6 |
| Incision/fixation of femur CPT 27165 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incision of achilles tendon CPT 27605 | $5,201.90 | $9,458.00 | $1,192.86 – $7,791.00 | 6 |
| Incision of achilles tendon CPT 27606 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incision of anal sphincter CPT 46080 | not published | not published | $2,059.07 – $5,298.68 | 6 |
| Incision of ankle bone CPT 28302 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Incision of bile duct CPT 47425 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of bile duct 47420 CPT 47420 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of brain tissue CPT 61541 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incision of brain tissue CPT 61567 | not published | not published | $6,779.00 – $6,779.00 | 1 |
| Incision of breast lesion CPT 19020 | not published | not published | $1,225.21 – $7,791.00 | 6 |
| Incision of brow nerve CPT 64732 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Incision of burn scab initi CPT 16035 | not published | not published | $301.57 – $2,334.00 | 6 |
| Incision of cheek nerve CPT 64734 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Incision of chin nerve CPT 64736 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Incision of eardrum CPT 69420 | not published | not published | $175.70 – $2,334.00 | 6 |
| Incision of eardrum CPT 69421 | not published | not published | $2,459.51 – $6,329.15 | 6 |
| Incision of esophagus CPT 43020 | not published | not published | $1,151.01 – $4,761.00 | 6 |
| Incision of eye CPT 65850 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Incision of eye CPT 66172 | not published | not published | $1,712.02 – $7,791.00 | 6 |
| Incision of eyelid CPT 67710 | not published | not published | $739.52 – $4,761.00 | 6 |
| Incision of facial nerve CPT 64742 | not published | not published | $1,448.59 – $7,791.00 | 6 |
| Incision of fibula CPT 27707 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Incision of finger tendon CPT 26455 | not published | not published | $1,192.86 – $4,761.00 | 6 |
| Incision of foot fascia CPT 28008 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incision of foot tendon 28234 CPT 28234 | not published | not published | $1,192.86 – $7,791.00 | 6 |
| Incision of gallbladder 47480 CPT 47480 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of heel bone CPT 28300 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Incision of hip bone CPT 27146 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incision of hip bones CPT 27151 | not published | not published | $3,735.00 – $18,364.00 | 6 |
| Incision of hip tendon CPT 27000 | $2,653.75 | $4,825.00 | $1,192.86 – $7,791.00 | 6 |
| Incision of hip tendon CPT 27001 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Incision of hip tendon CPT 27003 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Incision of hip tendons CPT 27006 | $3,865.95 | $7,029.00 | $2,427.27 – $8,770.00 | 6 |
| Incision of iris CPT 66500 | not published | not published | $1,712.02 – $4,405.59 | 6 |
| Incision of iris CPT 66505 | not published | not published | $1,712.02 – $4,761.00 | 6 |
| Incision of jaw joint CPT 21010 | not published | not published | $2,459.51 – $7,791.00 | 6 |
| Incision of jaw nerve CPT 64738 | not published | not published | $1,448.59 – $4,761.00 | 6 |
| Incision of knee joint CPT 27435 | not published | not published | $2,427.27 – $8,770.00 | 6 |
| Incision of liver duct CPT 47400 | not published | not published | $3,735.00 – $3,735.00 | 1 |
| Incision of lymph channels CPT 38308 | not published | not published | $2,904.59 – $7,791.00 | 6 |
| Incision of metatarsal CPT 28306 | not published | not published | $5,382.89 – $13,851.98 | 6 |
| Incision of metatarsal CPT 28307 | not published | not published | $3,735.00 – $13,851.98 | 6 |
| Incision of metatarsal CPT 28308 | not published | not published | $2,427.27 – $7,791.00 | 6 |
| Incision of metatarsals CPT 28309 | not published | not published | $5,382.89 – $18,364.00 | 6 |
| Incision of midfoot bones CPT 28304 | not published | not published | $5,382.89 – $18,364.00 | 6 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.